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Pervasive Income-Based Disparities In Inpatient Bed-Day Rates Across Conditions And Subspecialties
Andrew F Beck1, Carley L Riley2, Stuart C Taylor3
1Andrew F. Beck ( andrew.beck1@cchmc.org ) is an associate professor of pediatrics at the University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, in Ohio.
Insights
Poorer communities experience disproportionately higher pediatric hospitalization rates. Addressing health disparities could significantly reduce overall hospitalizations, improving health equity for children.
Area of Science:
- Public Health
- Health Services Research
- Pediatric Hospitalization
Background:
- A culture of health in hospitals extends beyond community partnerships.
- Recognizing and responding to population-level utilization disparities is crucial.
- Understanding socioeconomic factors influencing healthcare access is essential.
Purpose of the Study:
- To analyze pediatric hospitalization patterns in relation to socioeconomic status.
- To identify geographic disparities in inpatient bed-day rates.
- To quantify potential reductions in hospitalizations by addressing socioeconomic disparities.
Main Methods:
- Geocoding of pediatric hospitalizations from 2011-2016 at Cincinnati Children's Hospital Medical Center.
- Calculation of inpatient bed-day rates per census tract in Hamilton County, Ohio.
- Stratification of bed-day rates by quintiles of child poverty and analysis of specific conditions/subspecialties.
Main Results:
- Poorer communities exhibited disproportionately higher pediatric hospitalization burdens.
- If affluent tract rates were applied county-wide, approximately 22 child-years of hospitalization could be prevented annually.
- High-poverty census tracts near the hospital showed bed-day rates more than double the county average.
Conclusions:
- Hospitals must develop a comprehensive understanding of the 'culture of health' to effectively address disparities.
- Reducing socioeconomic disparities in healthcare utilization can lead to significant reductions in pediatric hospitalizations.
- Internal hospital culture and community engagement are both vital for achieving health equity.
Abstract:
Building a culture of health in hospitals means more than participating in community partnerships. It also requires an enhanced capacity to recognize and respond to disparities in utilization patterns across populations. We identified all pediatric hospitalizations at Cincinnati Children's Hospital Medical Center, in the period 2011-16. Each hospitalized child's address was geocoded, allowing us to calculate inpatient bed-day rates for each census tract in Hamilton County, Ohio, across all causes and for specific conditions and pediatric subspecialties. We then divided the census tracts into quintiles based on their underlying rates of child poverty and calculated bed-day rates per quintile. Poorer communities disproportionately bore the burden of pediatric hospital days. If children from all of the county's census tracts spent the same amount of time in the hospital each year as those from the most affluent tracts, approximately twenty-two child-years of hospitalization time would be prevented. Of particular note were "hot spots" in high-poverty census tracts neighboring the hospital, where bed-day rates were more than double the county average. Hospitals that address disparities would benefit from a more comprehensive understanding of the culture of health-a culture that is more cohesive inside the hospital and builds bridges into the community.
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